General Principles of Fractures and Joint Injuries
DEFINITION: A fracture indicates disruption of the continuity of the bone. This can involve a simple disruption of the periosteum and indentation to complete separation of the fracture segments.
CAUSES OF FRACTURE
Age and Sex: Fracture can occur at any age but are more common during the active period of life. Amongst the elderly people, the bones may be weakened by porosis and are liable to break by trivial injuries. The neck of femur, for example, bears the burden of fracture very often in old women due to postmenopausal porotic condition.
Violence: Fractures are produced by violence which exceeds the strength of the bone. This violence can be of a (a) direct or (b) indirect type.
- Direct Violence: This may be due to a direct hit or to part of the body being trapped between two opposing forces producing a crushing injury. The former type usually produces a transverse fracture whereas the latter results in a comminuted lesion.
- Indirect Violence: this type of injury occurs by the transmission of stress to a place of bony architecture distant from the site of impact, e.g., fracture of clavicle after falling on the outstretched hand. The force is transmitted upwards along the upper limb to the clavicle.
Torsional Injury: This is produced by a twisting sprain. When this foot is fixed on the ground, a sudden twisting movement of the leg can produce a fracture of the tibia.
Stress: Continuous stress may produce fatigue of the bone which can give way without being exposed to direct violence. This usually happens in the lower limb which must bear the burden of the body weight. The lesion can affect either the tibia, metatarsal bones or neck of the femur.
Muscular Contraction: Sudden muscular contraction can produce fracture at the site of its attachment to the bone. Examples are fractures of the greater tuberosity of the humerus, patella, and fractures in convulsive diseases.
- Fracture of the greater tuberosity of the humerus: Abduction force on the shoulder can produce the fracture of the greater tuberosity of the humerus. This can due to the sudden contraction of the supra and infraspinatus muscles.
- Fracture of the patella: The patella may similarly sustain fracture by the sudden contraction of the quadriceps.
- Fractures in convulsive diseases: The diseases of convulsive nature like tetanus and epilepsy can produce fractures by sudden spasmodic contraction of the muscles.
TYPES OF FRACTURES
The types of fractures that are produced depend generally on the nature of the injury, e.g., direct, crushing or a twisting force. The age of the patient has a characteristic influence. Children suffer mainly from greenstick fracture due to the soft texture of the bony architecture.
Displaced and Undisplaced Fractures: This terminology is applied to the amount of displacement of the fracture may be undisplaced, partly displaced or completely displaced.
Transverse Fracture: In this variety, the fracture line passes transversely. The process of union is slow because of the lesser fractured surface area in comparison to the other types. When the fracture surfaces are in apposition there is stability at the site of the fracture. In cases where there are displacements of the segments, the fractures must be reduced and any deformity corrected.
In transverse fracture of the tibia, weight-bearing can be encouraged at an early date because of the stability at the site of the lesion.
Oblique and Spiral Fractures: These types are produced by twisting injuries.
The process of the union can be quick because of the large fractured surface areas being opposed to each other.
The stability is not good and weight- bearing with these types of lesions in the lower limbs should be delayed. The oblique verities of the fracture tend to form a gliding surface when early weight- bearing is allowed. This is therefore deferred till the radiological evidence of union is very sound. In these types, success may be obtained by closed reduction, but displacement may take place even after reduction because of the oblique nature of the fracture line. Open reduction and fixation with screw can be a simple device. This will provide perfect apposition and stability.
Impacted Fracture: Th fractured segments are driven into one another and become impacted. The fracture is stable, but this must be immobilized, otherwise, displacement is likely to occur. The union is quick in this type of lesion.
Comminuted Fracture: This is the result of severe direct injury, usually that of a crushing variety. The bone is broken into several segments. The fracture is unstable and is difficult to retain in the reduced position.
Butterfly Fracture: The bone breaks into three pieces and one small triangular segment lies in between the two main bone pieces. The segment looks like a butterfly.
Segmental Fracture: The bone is broken into several segments. In most cases, there is a free intervening segment in between the two main pieces. Trauma Bone Plate is used to immobilize the fracture.
Avulsion Fracture: Sudden contraction of muscles can avulse a segment of bone. This can happen in fracture of the greater tuberosity of humerus and fracture of the calcaneum. These are the results of the sudden contraction of supraspinatus muscle and tendo- achillis.
Compression Fracture: This is produced by a compression force. The commonest site is the body of the vertebra. The bones of the lumber vertebra are more usually affected than the bones of the other parts of the body.
Fractures in Children
Green Stick Fracture: Amongst the children, the bones are not rigid. This causes the bone to break like a green stick with one surface intact. The periosteal continuity is maintained on one side while disruption takes place on the other. The green stick fracture is not always stable. The surgeon is using orthopedic implants to join the fractured bone. There may be instability in cases of spiral and comminuted fractures of the green stick variety.
Epiphyseal Injury in Children: The epiphyseal plate may be injured in children along with the interruption of its blood supply. The fracture separation of the epiphysis may take place along the transverse axis of the bone or it may split in a vertical direction. Defective development in the form of arrested growth or angular growth or angular deformity of the bone may develop after this type of injury. This is a result of interference with the epiphyseal blood supply and irregular new bone formation. Treatment of these fractures should be followed on the same principles as the fractures at other sites. Early proper reduction and its management checked by repeated x-ray can assure proper blood supply of the epiphysis and its further growth.
Compound Fracture: In this condition, fracture segments communicate with the exterior through breach of the skin. This may be produced due to causes from inside or from any outside.
Inside causes: The fractured bone may angulate, and the sharp bony projections may penetrate through the muscles and skin.
Causes from outside: The fracture area can be exposed by the loss of skin and soft tissues.
Risk of infection: This is high in compound fractures. Development of osteomyelitis is common ever after proper care of wound and use of antibiotics.
Implants Uses: Orthopedic Implants can be used to joint the fractured bone. Now a day’s orthopedic surgeon using implants to joint the fractured bone. There are several types of implants which is provided by the different company. Siora Surgical Pvt Ltd is the well-known name of orthopedic implants manufacturer and supplier.